Towards Measles elimination

In many European countries measles is still a cause of great public health concern. Outbreaks of the disease are still occurring because the degree of vaccination coverage required to interrupt transmission has not yet been achieved. Many countries have started to implement measles elimination strategies. These are primarily based on attaining a very high coverage of measles vaccination and strengthening measles surveillance systems.peer-reviewe

Obstetrics and gynaecology

A review of publications relating to significant advances in the specialty of Obstetrics and Gynaecology over the past four years will be discussed: topics reviewed will have an important impact on reducing maternal/fetal morbidity and mortality and should improve on woman's health care.peer-reviewe

A study of seroprevalence of rubella IgG in Maltese adolescents

The objective of this study was to determine the seroprevalence of rubella IgG antibodies in Maltese adolescents, through a cross-sectional study, with mailed questionnaire and blood sampling. The subjects tested were 172 individuals, aged 14-15 years from Malta and Gozo for the prevalence of vaccination and seropositivity (IgG) for rubella. The results of the 85% individuals vaccinated seropositivity was detected in 168 youths (97.7%). The study showed a high level of detectable humoral immunity to rubella but this could not be definitively attributed to vaccination alone.peer-reviewe

Skin ageing

Cutaneous ageing manifests itself as a progressive reduction in maximum function and reserve capacity of skin tissue. It is not a unique and uniform biological event. Skin comprises three layers: epidermis, dermis and subcutaneous tissue. Collagen atrophy is a major factor in skin ageing. There is a strong correlation between skin collagen loss and estrogen deficiency due to the menopause. Skin ageing, especially in the face, is associated with a progressive increase in extensibility and a reduction in elasticity. With increasing age, the skin also becomes more fragile and susceptible to trauma, leading to more lacerations and bruising. Furthermore, wound healing is impaired in older women. Estrogen use after the menopause increases collagen content, dermal thickness and elasticity, and it decreases the likelihood of senile dry skin. Large-scale clinical trials are necessary to help make informed recommendations regarding postmenopausal estrogen use and its role in the prevention of skin ageing.peer-reviewe

Mycoplasma pneumonia : an unusual cause of acute myocarditis in childhood

Mycoplasma pneumoniae is primarily a respiratory pathogen but may affect exhibit a diverse range of presentations from asymptomatic infection to life threatening conditions. Myocarditis of varying severity is an unusual complication. We report a 6 year old with mycoplasma myocarditis, a rare age for such a presentation, and who responded well to treatment with no sequelae. Serological testing for Mycoplasma pneumoniae should be part of the routine work-up for myocarditis.peer-reviewe

Orthogeriatrics in Malta : a 3 year experience

The orthogeriatric service in Malta started in 2012 and expanded in 2014. From admission, the patient is offered a ward based hip fracture programme that includes orthogeriatric assessment, management and co-ordinated multidisciplinary review. 457 patients were seen by the orthogeriatric service when this study was done. Mean age was 83 and 69% of patients were female. The Nottingham Hip Fracture Score (NHFS) is a scoring system that reliably predicts 30-day and 1-year mortality for patients after hip fracture. It is made up of seven independent predictors of postoperative mortality that have been incorporated into a risk score. The score ranges from 0-10 and the mean score for this cohort was 5.1. There was a statistically significant correlation between age and high NHFS scores. 30 day mortality was 5.9% and 1 year mortality was 24.4%. Compared with the Nottingham data both 30 day and 1 year mortality were less for the orthogeriatric department in Malta. The orthogeriatric service in Malta achieved better results when comparing mortality with the UK. In the future expansion of data collected should be considered to better evaluate standards of care in the department.peer-reviewe

Intervertebral disc height in treated and untreated overweight post-menopausal women

BACKGROUND: The effect of the menopause and HRT on the intervertebral discs has not been investigated. METHODS: One hundred women were recruited, comprising of 44 post-menopausal women on HRT, 33 untreated post-menopausal women and 23 pre-menopausal women. The height of the intervertebral discs between the 12th thoracic vertebra and the 3rd lumbar vertebra was measured by utilizing the bone densitometer height cursors. RESULTS: The untreated menopausal group of women had the lowest total disc height (D1–D3: 1.95 0.31 cm). This was significantly lower than the pre-menopausal group D1–D3: 2.16 0.24 cm) and the hormone-treated group (2.2 0.26 cm) (P > 0.02). The 2nd intervertebral disc consistently maintained a significant difference between the untreated menopausal group (D2: 0.63 0.13) and the other two groups (pre-menopausal group (D2: 0.72 0.09 cm) and treated menopausal group (D2: 0.73 0.12 cm) (P > 0.02). CONCLUSIONS: Estrogen-replete women appear to maintain higher intervertebral discs compared to untreated post-menopausal women. The estrogenic milieu may be relevant because of the significant impact it has on the hydrophilic glycosaminoglycans, the water content, collagen and elastin of the intervertebral discs. The maintenance of adequate disc height may allow the intervertebral discs to retain their discoid shape and viscoelastic function, containing vertical forces which may threaten spinal architecture leading to vertebral body compression fractures.peer-reviewe

Omentectomy in endometrial cancer : an evidence-based insight

Omentectomy is the surgical removal of the omentum. It is a routine component of staging surgery for confirmed or suspected ovarian carcinoma; however there is currently no consensus regarding omentectomy in surgery performed for endometrial cancer. Additionally, the extent of omental resection in patients without macroscopic deposits is unclear. A systematic search of PubMed MEDLINE resources was performed using the MeSH terms ‘endometrium’ ‘uterus’ ‘omentum’ ‘surgery’ ‘neoplasms’, and ‘neoplasm metastasis’. The authors conducted a literature review of articles published through January 2016 to summarize the current evidence analyzing omental assessment in endometrial cancer and the repercussions its involvement could have on patient management and prognosis. Metastasis to the omentum is a significant finding in endometrial cancer cases as it indicates upstaging to Stage IV-B (FIGO 2009). Assessment for omental spread helps indicate whether neoplastic deposits are spread beyond the conventional radiotherapy field and assist decision-taking with regards to platinum therapy. Macroscopic assessment of the omentum at the time of abdominal surgery for endometrial carcinoma has been shown to be highly sensitive and specific, and thus advisable. Omental biopsies and histopathological examination are more likely to affect management planning in cases at high-risk of upstaging, these being poorly differentiated tumors (Grade 2 and above), non-endometroid cytologies, cases with > 50% myometrial invasion, or cervical or adnexal involvement of the tumor. Total omentectomy and thorough histological assessment is superior with regards to detection of neoplastic spread however presents a significant strain on hospital laboratory services. Maximal surgical cytoreduction including omentectomy has been shown to improve overall survival in Stage 3 or 4 patients with good performance status.peer-reviewe

Handheld cellular telephone use and risk of brain cancer

Context. A relative paucity of data exist on the possible health effects of using cellular telephones. Objective. To test the hypothesis that using handheld cellular telephones is related to the risk of primary brain cancer. Design and Setting. Case-control study conducted in 5 US academic medical centers between 1994 and 1998 using a structured questionnaire. Patients. A total of 469 men and women aged 18 to 80 years with primary brain cancer and 422 matched controls without brain cancer. Main Outcome Measure. Risk of brain cancer compared by use of handheld cellular telephones, in hours per month and years of use. Results. The median monthly hours of use were 2.5 for cases and 2.2 for controls. Compared with patients who never used handheld cellular telephones, the multivariate odds ratio (OR) associated with regular past or current use was 0.85 (95% confidence interval [CI], 0.6-1.2). The OR for infrequent users (10.1 h/mo) was 0.7 (95% CI, 0.3-1.4). The mean duration of use was 2.8 years for cases and 2.7 years for controls; no association with brain cancer was observed according to duration of use (P=.54). In cases, cerebral tumors occurred more frequently on the same side of the head where cellular telephones had been used (26 vs 15 cases; P=.06), but in the cases with temporal lobe cancer a greater proportion of tumors occurred in the contralateral than ipsilateral side (9 vs 5 cases; P=.33). The OR was less than 1.0 for all histologic categories of brain cancer except for uncommon neuroepitheliomatous cancers (OR, 2.1; 95% CI, 0.9-4.7). Conclusions. Our data suggest that use of handheld cellular telephones is not associated with risk of brain cancer, but further studies are needed to account for longer induction periods, especially for slow-growing tumors wit

Charting the endometrial cancer care pathway : a baseline audit

Introduction: Longer waiting times from diagnosis to surgical resection have been found to negatively impact the overall survival and quality of life of women with endometrial cancer. The Cancer Care Pathway Directorate adopted the UK National Waiting Times Monitoring Dataset Guidance, to improve the timeliness of services along the cancer care pathway. From this, three key targets were identified: 1) Maximum 14-day wait from urgent GP referral for suspected cancer to first outpatient attendance (operational standard of 93%), 2) Maximum 31-day wait from decision to treat to first definitive treatment (operational standard of 96%), and 3) Maximum 62-day wait from urgent GP referral for suspected cancer to first treatment (operational standard of 85%). The aim of this baseline audit was to chart the time-frames of the various stages in the endometrial cancer pathway of patients diagnosed with this disease between 2015 and 2016 to assess for and identify delays in referral, investigation and care. -- Methods: A tool was developed following consultation with key stakeholders. Data protection clearance was obtained. Patient medical and oncology files, hospital databases, and MDT documentation for confirmed endometrial cancer cases were reviewed between September 2017 – March 2018. -- Results: A total of 101 endometrial cancer cases were included in the audit. The proportion of cases which met the 14-day, 31-day and 62-day wait KPIs operational standards were 39.1%, 81.2% and 17.2% respectively. -- Conclusion: The endometrial cancer care pathway timeframes did not meet the KPIs operational standards. Fast-track coordinators and nurse navigators could improve continuity and coordination of patient care.peer-reviewe